小儿泌尿系结石并急性肾功能衰竭41例临床分析

Clinical analysis of 41 children＇s urinary calculus and acute renal failure

目的探讨小儿泌尿系结石并急性肾功能衰竭的药物应用情况，以及合理的治疗方案。方法收集分析2008年7月至2012年6月收治的41例急性肾功能衰竭的患儿资料，泌尿系超声均提示双肾实质弥漫性回声增强，肾盏、肾盂及输尿管内可见明确泥沙样强回声沉积物，x线检查均未见结石显影。发病前均有头孢曲松钠等药物应用病史。所有患儿入院后均给予解痉及碱化尿液治疗，17例患儿联合应用血液透析治疗，4例行输尿管镜下输尿管置管。结果24例患儿经单纯解痉、碱化尿液治疗后24h内恢复排尿，11例给予血液透析1次恢复排尿，2例经血液透析2次后恢复排尿，4例行输尿管镜下输尿管置管术后恢复排尿。1周后复查彩色多普勒超声，39例结石完全消失，肾实质回声恢复正常。2例残留结石直径小于5mm，无自觉不适症状，出院后给予枸橼酸氢钾钠颗粒口服，1个月后复查结石消失。结论药物应用不当可能导致小儿泌尿系结石并急性肾功能衰竭，及时停药并给予解痉、碱化尿液治疗，必要时辅以血液透析或输尿管置管可以有效逆转肾功能损害，结石多在尿量正常后排出。

Objective To analyze the treatment of acute renal failure caused by irrational drug use. Method Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by uhrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement. Result In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children＇s calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later. Conclusion Irrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.